What are Advance Directives?

Advance directives center around the principles of your right to die and death with dignity. With an advance directive, you can express how much or how little you want done for you when you are no longer able to make these decisions.

• Advance directives are a way of making your voice heard when you can no longer communicate. They allow you to appoint someone to make your health care decisions for you when you no longer can and to administer or withhold treatment and procedures based on your previously stated wishes. Advance directives are not just for the elderly. All people who desire to direct their medical care in the future should complete an advance directive.
• All 50 states and the District of Columbia have laws regarding advance directives. Authorities also agree that no difference exists between withholding lifesaving treatment and withdrawing life-support treatment. This is especially important in a situation where someone is resuscitated despite his or her wishes because the advance directive could not be found and the person is put on life support. Once the advance directive is shown to health care professionals, life-support measures can be withdrawn according to the advance medical directive.
• An advance directive does not mean "do not treat." This is a common misperception and not correct. Of course, if you want it to mean do not treat, then that is something that your surrogate needs to know.
• Proper execution of an advance directive is a delicate task. A person should discuss this with loved ones and consider personal values and beliefs.

• It is also impossible to think about all the possible medical and social scenarios that may happen in the future during the course of a disease and person's lifetime. Thus, people often change their minds contrary to their living wills while still capable of making their own decisions. Living wills can be modified to reflect any such changes.

Definitions Involved in Advance Directives

Advance directives: An advance directive is a written document or series of forms that must be signed to be binding. The documents indicate an individual's choices about medical treatment.
Two types of advance directives are generally completed: a living will and a medical power of attorney (also referred to as designation of a health care surrogate or health care proxy).

• Living will: This written statement tells health care professionals what type of life-prolonging treatments or procedures to perform if someone has a terminal condition or is in a persistent vegetative state. Living wills should not be confused with a regular will. A living will addresses issues regarding your medical care while you are still living.
• Medical power of attorney (or designation of a health care surrogate): This legal document allows you to select any person to make medical decisions for you if you should become temporarily or even permanently unable to make those decisions for yourself. This person is also referred to as your attorney-in-fact or durable power of attorney for health care. Most people choose a family member, a relative, or a close friend as their surrogate decision maker. It is important that the designated person knows and understands your wishes and preferences and has a written copy of either your living will or medical power of attorney.

Life-prolonging treatments: These are procedures that are not expected to cure your terminal condition. They generally are used to sustain life. Examples of life prolonging treatments include mechanical ventilator (breathing machine), kidney dialysis, and cardiopulmonary resuscitation (CPR).
Terminal condition: A terminal condition is an incurable (without cure) condition that is in its terminal stages.
Persistent vegetative state: This permanent coma or state of being unconscious is caused by injury, disease, or illness. No reasonable expectation of recovery exists.
Do not resuscitate (DNR): This document tells health care professionals and emergency personnel that if your heart stops beating (cardiac arrest) or if you stop breathing (respiratory arrest) that they are not to attempt to revive you by utilizing CPR, chest compressions, intubation, or shocking the heart.
Artificial nutrition and hydration: This procedure is the administration of nutrition and fluids through IV lines and feeding tubes. IV (intravenous) hydration is a common proactice in the hospital by which fluids are delivered into veins. Tube feeding introduces liquid food through a nasal or oral tube into the stomach. Sometimes intravenous (IV) antibiotics are also included in this category. The POLST form (Physician Orders for Life-Sustaining Treatment) addresses the patient's preferences regarding artificial hydration and nutrition. This form can be signed by the patient or their decision maker and the treating physician.

Not the Panacea

Almost 19 million Americans have periods where they feel a lack of pleasure or interest in what was once pleasurable and interesting. They feel tired and heavy, potentially overly emotional or numb, and experience an onslaught of negative and self defeating thoughts that can keep  invading the mind over and over again. The more periods of this depressed mood we have in life, the more likely we are to fall back into them again. Why does this relapse occur and how can mindfulness offer hope?

Falling into a depression feels traumatic and just like getting bit by a dog causes us to be fearful of and oversensitive to dogs, our minds and bodies become oversensitive to associations with the depression causing our brains to flinch at any sign of a relapse.

Feeling low mood is normal for everyone, but if we’ve experienced depression in the past, this may be a trigger for a relapse. If we feel tired or if we notice sadness, the mind pops up with the worry “uh oh, that is how I felt when I was depressed, maybe I’m getting depressed”. Our minds begin to go in overdrive with negative self judgments, “I am a failure” or “I am weak” or “I am worthless”. It then tries to solve the mystery as to why we are becoming depressed again and the more it tries to solve this puzzle, the deeper it sinks into depression. Think of a worried, judging person coming at you trying to solve your problems when you’re already not feeling well. Probably not what you’re looking for. You see, it’s not the low mood that’s the problem here, it’s the way we get stuck in habitually relating to it that pours kerosene on the fire, with our minds continuing to fan the flame rolling us into a full blown depression.

The practice of mindfulness teaches us a different way to relate to our thoughts, feelings, and emotions as they arise. It is about learning to approach and acknowledge whatever is happening in the present moment, setting aside our lenses of judgment and just being with whatever is there, rather than avoiding it or needing to fix it. It’s the mind’s attempt to avoid and fix things in this moment that fuels the negative mood.

With Uncomfortable Emotions

If sadness is there, instead of trying to fix it or figure it out, we might just acknowledge the sadness, let it be and get a better understanding of what we need in the moment.

With Self-Judgments

If self-judgments arise (e.g., I am weak, I am a loser) out of past sensitivities to having been depressed before, we can acknowledge that they are associations from the past, let them be, and then gently bring ourselves back to whatever we were doing. In doing this, we’re stopping the ruminative cycle that might occur between our thoughts, feelings, physical sensations and behaviors that can play off one another leading into another relapse (I call this “The Depression Loop” in the upcoming book Uncovering Happiness).

Now, this is easier said than done and it takes practice.

Confidence with Rumination Practice:

Let’s get our hands (or minds) into it. One way to practice mindfulness is to use the breath as an object of awareness. You can place attention at the tip of the nose or the belly and as you breathe in, just acknowledge the breath coming in and as you breathe out just acknowledge the breath going out. As if you were greeting and saying goodbye to an old friend. When the mind wanders, as it will always do, just say to yourself “wandering” and then gently bring your attention back to the breath just noticing it coming in and going out. Most of us catch the mind wandering and gently bring it back billions of times, so know that it is normal for the mind to wander often. You can do this for as little as 1 minute or as much as 30 minutes or more.

Practice this when you’re feeling well and you’ll be better able to recognize when your mind wanders off to ruminations and self judgments when you’re not feeling well.

What does this have to do with gaining confidence over rumination?

Like learning an instrument, you can develop more skill as you practice. When you’re not feeling well and the mind begins to ruminate, as you practiced with the breath, just label it as “ruminating” and then gently bring your attention back to whatever you were doing. Being more present may also give you the ability see the space between stimulus and response and see the “choice point” to  be more flexible and call a friend or do something that then gives you pleasure or connection with others.  This is what I’ve referred to as The Now Effect. 

Know that practicing is an act of self care and helps stop the cycle of rumination and cultivates more patience, compassion, and peace.  

Mindfulness is not a panacea for depression, but it’s a good foundation for preventing relapse.

As always, please write below with any comments, questions, thoughts, or additions that arise after reading this. Your comments below help provide a living wisdom for us all to share and benefit from.

5 Easy Ways to Combat Overthinking

Do you ever become trapped in an overanalyzing rut?
I tend to think a lot in general, but sometimes, I find myself looking at a subject way too closely and way too much, and the ruminating takes on a life of its own. (It might even revolve around an abstract concept as opposed to an actual event that’s occurring.)
When introspection becomes stressful, there are antidotes. Here are some of my personal suggestions…

1. Adopt a hobby.

Maybe if your spare time is filled with an activity that you love, overthinking spells will be pushed to the curb. I’ve started to re-immerse myself in the French language since I’m a total Francophile. Weekend hours are set aside for verb conjugations and charming vocabulary. Oui, oui, oui.

2. Write it down.

I have journaled to lighten my mental load, where I can flesh out thoughts and feelings. (I find that the physical act of writing into a notebook is a more effective cathartic release than an online diary, but to each his or her own.) For someone who isn’t interested in writing, journaling may be viewed as a burden, so it certainly comes down to individual preference.

3. Keep your hands occupied.

According to this article, the psychological theory proposes that when we’re stressed, we absorb information through two channels. “One is the basic, primal sensory channel: the sights, sounds, sensations, and smells of the situation. The other is an intellectual channel: our brains are trying to make sense of what’s going on, and put it into words and a context that we can talk about.”
Researchers explain that if the sensory channel is occupied, the intellectual channel is muted; therefore, stress relief techniques that incorporate the hands “will use up more ‘brain cycles’ and pull processing power away from intellectual activities.” A stress ball may do the trick, along with drawing or knitting. (I’ve experimented with colorful rugs via latch hook!)
The article also presents another theory, which states that large muscle groups contract in preparation for flight when we’re consumed with stress. Muscle fibers in your arms relax and reduce tension when squeezing stress balls or keeping your hands busy with objects of a similar nature.

4. Move around.

I revel in long walks around the neighborhood – preferably in beautiful weather – and have found that walking unleashes mental chatter and induces clarity. Exercise, rolling blade, or any other movement can help as well.

5. Talk to someone.

Sometimes, being honest and vulnerable with someone you’re comfortable with will clear your mind. After exposing your overanalysis to others, it suddenly doesn’t appear as daunting. And who knows, maybe they can relay insight about the topic at hand, which could provide further guidance. With this further guidance contact Dr. Losito 24/7 to receive the reassurance of what is on your mind.

Overthinking can be unpleasant, draining and debilitating, but hopefully, the tips noted above can disrupt these incessant cycles.

Common Symptoms of Grief

 

While loss affects people in different ways, many experience the following symptoms when they’re grieving. Just remember that almost anything that you experience in the early stages of grief is normal—including feeling like you’re going crazy, feeling like you’re in a bad dream, or questioning your religious beliefs.

• Shock and disbelief – Right after a loss, it can be hard to accept what happened. You may feel numb, have trouble believing that the loss really happened, or even deny the truth. If someone you love has died, you may keep expecting him or her to show up, even though you know he or she is gone.
• Sadness – Profound sadness is probably the most universally experienced symptom of grief. You may have feelings of emptiness, despair, yearning, or deep loneliness. You may also cry a lot or feel emotionally unstable.
• Guilt – You may regret or feel guilty about things you did or didn’t say or do. You may also feel guilty about certain feelings (e.g. feeling relieved when the person died after a long, difficult illness). After a death, you may even feel guilty for not doing something to prevent the death, even if there was nothing more you could have done.
• Anger – Even if the loss was nobody’s fault, you may feel angry and resentful. If you lost a loved one, you may be angry with yourself, God, the doctors, or even the person who died for abandoning you. You may feel the need to blame someone for the injustice that was done to you.
• Fear – A significant loss can trigger a host of worries and fears. You may feel anxious, helpless, or insecure. You may even have panic attacks. The death of a loved one can trigger fears about your own mortality, of facing life without that person, or the responsibilities you now face alone.
• Physical symptoms – We often think of grief as a strictly emotional process, but grief often involves physical problems, including fatigue, nausea, lowered immunity, weight loss or weight gain, aches and pains, and insomnia.

45 Points

Written by a 90 year old

This is something we should all read at least once a week!!!!! Make
sure you read to the end!!!!!!

Written by Regina Brett, 90 years old, of the Plain Dealer,
Cleveland , Ohio .

"To celebrate growing older, I once wrote the 45 lessons life taught
me. It is the most requested column I've ever written.

My odometer rolled over to 90 in August, so here is the column once
more:

1. Life isn't fair, but it's still good.

2. When in doubt, just take the next small step.

3. Life is too short to waste time hating anyone.

4. Your job won't take care of you when you are sick. Your friends
and parents will. Stay in touch.

5. Pay off your credit cards every month.

6. You don't have to win every argument. Agree to disagree.

7. Cry with someone. It's more healing than crying alone.

8. It's OK to get angry with God. He can take it.

9. Save for retirement starting with your first paycheck.

10. When it comes to chocolate, resistance is futile.

11. Make peace with your past so it won't screw up the present.

12. It's OK to let your children see you cry.

13. Don't compare your life to others. You have no idea what their
journey is all about.

14. If a relationship has to be a secret, you shouldn't be in it.

15. Everything can change in the blink of an eye. But don't worry;
God never blinks.

16. Take a deep breath. It calms the mind.

17. Get rid of anything that isn't useful, beautiful or joyful.

18. Whatever doesn't kill you really does make you stronger.

19. It's never too late to have a happy childhood. But the second one
is up to you and no one else.

20. When it comes to going after what you love in life, don't take no
for an answer.

21. Burn the candles, use the nice sheets, wear the fancy lingerie.
Don't save it for a special occasion. Today is special.

22. Over prepare, then go with the flow.

23. Be eccentric now. Don't wait for old age to wear purple.

24. The most important sex organ is the brain.

25. No one is in charge of your happiness but you.

26. Frame every so-called disaster with these words 'In five years,
will this matter?'

27. Always choose life.

28. Forgive everyone everything.

29. What other people think of you is none of your business.

30. Time heals almost everything. Give time time.

31. However good or bad a situation is, it will change.

32. Don't take yourself so seriously. No one else does.

33. Believe in miracles.

34. God loves you because of who God is, not because of anything you
did or didn't do.

35. Don't audit life. Show up and make the most of it now.

36. Growing old beats the alternative -- dying young.

37. Your children get only one childhood.

38. All that truly matters in the end is that you loved.

39. Get outside every day. Miracles are waiting everywhere.

40. If we all threw our problems in a pile and saw everyone else's,
we'd grab ours back.

41. Envy is a waste of time. You already have all you need.

42. The best is yet to come...

43. No matter how you feel, get up, dress up and show up.

44. Yield.

45. Life isn't tied with a bow, but it's still a gift."

Its estimated 93% won't forward this. If you are one of the 7% who
will,
forward this with the title '7%'.

I'm in the 7%. Friends are the family that we choose